Insurance Coverage estimated but denied?
Question:
What are my rights for being informed of elegibility? For example, what were the numbers based on if I was not eligible?
From my perspective, we were led to believe there was eligibility there and we made our choices based on this faulty information given by the provider.
Same with the hospital. Why is there a pre-certification phone line, but they can't tell me until after i have bought the services that I am not covered.
I feel like I was not afforded the right to make an informed decision. On top of that, the services were not properly rendered. They didn't monitor my wife properly and the pertosin was administered when she was already 4 cm. The delivery doctor was only there for 5 minutes. They forgot to collect the cord blood. They performed tests that we waived and billed us for them. How do I fight?
Answers:
Be prepared for an endless battle, my daughter has been fighting incorrect hospital charges for seven years. Contact your states insurance board, they may have a different name for it where you are, I hope you saved any correspondence with the company that you had to back up your claim.
Usually insurance companies do what they can to deny what they can get away with, and they get away with a lot. Perseverance is whats needed. They refused to pay for an operation of mine saying it wasn't covered, after almost six months, they finally agreed to cover it when I got the State involved. The company sent me the section of the rules that they said showed they didn't have to cover it. But the rules said exactly the opposite. I can only assume they do that in the hopes that you don't fight, and you don't read.
Next time someone tells you how wonderful the current US system is, you will have your own story to tell.
call or go into the hospital billing office. you should have had or the hospital a pre-admit insurance approval. that is good enough on your part, the hospital must due all filling and fighting with insurance company.
as for unnecessary charges, refuse to pay.
when my wife get birth to our last child, an addional dr came into delivery room to look at the trim job i had given to my wife's pubic hair
he charged 900.00
insurance paid him 100.00 i paid him 0 and reported him and his comments that were on my camcorder to state medical board.
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